Prickly Heat or Miliaria (miliaria rubra, sweat rash ) is a skin disease marked by small and itchy rashes. Miliaria is a common ailment in hot and humid conditions, such as in the tropics and during the summer season. Although it affects people of all ages, it is especially common in children and infants due to their underdeveloped sweat glands.

It is a skin rash caused by trapped sweat under the skin. Sweat can become trapped when the narrow ducts through which sweat travels to the surface become clogged. Prickly heat tends to be more common in warmer, more humid climates. The condition usually appears on the torso and thighs.Pathology
Miliaria (Prickly Heat) occurs when the sweat gland ducts get plugged due to dead skin cells or bacteria such as Staphylococcus epidermidis, a common bacterium that occurs on the skin which is also associated with acne. The trapped sweat leads to irritation (prickling), itching and to a rash of very small blisters, usually in a localized area of the skin.

Prickly heat develops when the narrow ducts carrying sweat to the skin surface get clogged. The trapped sweat causes inflammation, which produces irritation (prickling), itching, and a rash of very tiny blisters. Prickly heat also can appear as large, reddened areas of skin.Prickly heat results when sweat glands are blocked and ruptured, and sweat is trapped below the skin.

Clinical features:
Symptoms of miliaria include small red rashes, called papules, which may itch or more often cause an intense ‘pins-and-needles’ prickling sensation. These rashes may simultaneously occur at a number of areas on a sufferer’s body, the most common including the face, neck, under the breasts and under the scrotum. Other areas include skin folds, areas of the body that may rub against clothing, such as the back, chest, and stomach, etc. A related and sometimes simultaneous condition is folliculitis, where hair follicles become plugged with foreign matter, resulting in inflammation.

The following are the most common symptoms of prickly heat. However, each individual may experience symptoms differently:

The symptoms relating to miliaria should not be confused with shingles as they can be very similar. Shingles will restrict itself to one side of the body but also has a rash-like appearance. It is also accompanied by a prickling sensation and pain throughout the region. Those who suspect they have shingles and not miliaria should seek medical advice immediately as the sooner antivirals are taken, the better.

Other types of miliaria:
In a similar mild condition called miliaria crystallina, instead of small rashes, there are tiny blisters that look like beads of perspiration. miliaria profunda, sometimes referred to as Wildfire due to the rapid spread and severe burning sensations, is a severe form of miliaria caused by a complication due to repeated outbreaks of miliaria rubra, the sweat ducts are completely blocked. This inability to sweat may cause the patient to be prone to heat exhaustion. Once triggered, a severe attack of miliaria commonly lasts 5-6 weeks because the plugs which form in the sweat duct openings can only be cast off by the outward growth of the sweat duct cells.

The most severe forms of prickly heat have very similar symptoms to severe burns. The term Wildfire is used because the generation of excess heat and the inability to expel the heat can lead to a cascade effect where the trapped sweat causes blisters to break, the immune system, adrenal system, and patient psychological response to the pain and panic response to the rapidly spreading rash causes additional biological activities and heat and the entire system cascades (or breaks down). The rash can be visually seen to progress rapidly similar to scenes from various horror movies, accompanied by the associated pain which will become quite severe.

Prevention:
Prickly heat can be prevented by avoiding activities that induce sweating, using air conditioning to cool the environment, wearing light clothing and in general, avoiding hot and humid weather. If that is not possible, and especially if air conditioning is unavailable or unaffordable, then taking multiple showers throughout the day (and night as well if needed) to unplug and clean the sweat glands is the best defense against it.

Treatment:

The condition usually clears up when sweating is avoided. Other treatment may include:

keeping the skin cool and dry

corticosteroid lotions

There is currently little in the way of specific medical treatment, but in most cases the rashes disappear by themselves. Severe infections can last weeks. Early and continuous treatment of minor infections can effect recovery within a matter of days. Staying in an air-conditioned environment to avoid sweating will speed-up the healing process and lessen symptoms. Anti-itch lotions, such as calamine and topical steroid creams can be used to sooth and control the itching. Use caution however as anything which blocks the release of sweat and heat and in particular oil based products block the glands and slow the defoliation process and should be avoided. Antibiotics and topical antiseptics are used to prevent bacterial blooms, reducing the chances of the sweat glands being plugged and causing inflammations. In some cases, vitamin A and C supplements can help shorten the duration and severity of the symptoms. Prickly heat powders, using antibacterial agents and ingredients like menthol and camphor with mild analgesic and cooling properties, can be applied to the affected areas to relieve the itching and discomfort. Healing takes time even when bacteria are reduced as new sweat gland cells need time to regrow as the damaged cells defoliate.

Instead of medicating, it is usually best to simply keep the skin clean by taking multiple showers to keep affected areas clean and sweat free. Stay calm and stay cold. Dunking in cold water is effective. Mild antibacterial soaps may be helpful as well to slow spread and prevent future outbreaks. In most cases, these simple steps alone will make the rashes disappear naturally in a few days. If they persist, it may be advisable to consult a doctor in case a more serious infection is occurring.

In the cases where the rash has caused open blisters to form a doctor should be consulted immediately as the open sores are almost certain to infect and cause secondary problems without preventative measures.

Homeopathy :
To prevent heat rash, take a 30C dose of Sol three times a day for up to three weeks, writes Andrew Lockie, M.D., in his book The Family Guide to Homeopathy. If you do develop a rash, Dr. Lockie recommends trying a 30C dose of Apis as soon as the prickling or itching sensation starts. Take this remedy every two hours for up to ten doses, he says, and repeat this routine daily, if necessary.
Sol and Apis are available in many health food stores. To purchase homeopathic remedies by mail, refer to the resource list on page 637.

Food Therapy
To get over heat rash more quickly, increase your intake of essential fatty acids, advises Julian Whitaker, M.D., founder and president of the Whitaker Wellness Center in Newport Beach, California. â€œSalmon and other cold water fish (such as herring and mackerel) are excellent sources of these fatty acids, as are flaxseed oil and dark green leafy vegetables such as spinach.â€ Flaxseed oil is available in most health food stores.

Hydrotherapy :
Take an alkaline bath to soak away heat rash, suggests medical pathologist Agatha Thrash, M.D., co-founder and co-director of Uchee Pines Institute, a natural healing center in Seale, Alabama. Add one cup of baking soda to a tub filled with lukewarm water (94 to 98°F; you can use a regular thermometer to check) and soak for 30 to 60 minutes, using a cup to pour the water over any part of the body that isn’t submerged in the bath. Pat dry.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

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